The Relationship Of Cognitive Impairement And Subcortical Features In Patients With Subcortical Ischemic Vascular Disease

ObjectiveThe aim of study is to explore neuropsychological characteristics of magnetic resonanceimaging(MRI)-defined subcortical ischemic vascular disease (SIVD) by usingneuropsychological scale; and to investigate the relationship between cognitiveimpairment and the other subcortical features in patients with SIVD by applying a rangeof screens and clinical manifestations to assess subcortical features of the patients withSIVD.MethodsWe tested the objects of interest by using a series of neuropsychological screensincluding Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment(MoCA), the Cambridge cognitive examination-Chinese version (CAMCOG-C), theclock drawing task (CDT), and Activity of Daily Living Scale (ADL). Combined withthe brain MRI, we finally chose110subjects. All the subjects were divided into3groups according to cognitive status by neuropsychological tests: with non-cognitionimpairment(SIVD-NCI, n=34), with mild cognitive impairment (SIVD-MCI, n=47) andwith vascular dementia (SIVD-VaD, n=29). We also assessed all the subjects whethersubcortical features were presence. Depression symptoms were assessed by the geriatricdepression scale (GDS) while gait balanced ability test by timed up and go test (TUG).Combined with clinical manifestations, we assess all the subjects whether they sufferedfrom urinary disorder, pseudobulbar palsy, emotional incontinence and falls. We compared MMSE, MoCA, CAMCOG-C, CDT and ADL scores and analyze subcorticalfeatures at different stages of cognitive impairment in patients with SIVD.Results(1) In the socio-demographic factors, no significant difference was observed among thethree groups in the sex, age and education years. In vascular risk factors, there were alsono statistically significant differences in hypertension, hyperlipidemia, heart disease,diabetes prevalence and smoking rates.(2) Both SIVD-VaD (18.1±3.9；13.8±3.8；64.7±12.3；4.0±2.6) and SIVD-MCI (24.5±2.4；18.5±4.0；78.5±11.3；5.6±2.8) Groupsshowed significantly lower than SIVD-NCI group (28.4±1.2；23.2±3.0；92.1±6.5；8.0±2.5) in MMSE, MoCA, COMCOG-C and CDT scores (Both P<0.05), comparedwith SIVD-MCI group, the MMSE, MoCA, COMCOG-C and CDT scores weresignificantly lower in SIVD-VaD group(P<0.05). There were significantly higher ADLscores in SIVD-VaD (42.8±16.0) and SIVD-MCI (30.6±11.2) groups compared withSIVD-NCI group (22.7±5.2)(P<0.05), and in SIVD-VaD group compared withSIVD-MCI group (P<0.05).(3) Gait disturbance, urinary disorder, pseudobulbar palsy,depression and falls were statistically significant among the three groups (χ2=21.696、21.412、25.512、6.913、21.871，both P<0.05). In addition, gait disturbance increasinglyaggravated with the severity of cognitive impairement. In SIVD-MCI group, urinarydisorder, pseudobulbar palsy and falls increased significantly compared with SIVD-NCIgroup (χ2=15.570、16.305、8.924， both P<0.05). Depression was statisticallysignificant between SIVD-NCI and SIVD-VaD group(χ2=6.901，P<0.017). Among thethree groups, there was no significant difference in the subcortical features of emotionalincontinence.Conclusion(1) With the decline of cognitive function, the patients with SIVD will present with different subcortical features.(2) Gait disturbance was further aggravated with the decline of cognitive function. Thesubcortical features including urinary disorder, pseudobulbar palsy and falls may reflectthe cognitive impairement from normal to watershed; Depressive symptoms may reflectwhether the cognitive impairment of patients with SIVD reach the degree of dementia.(3) When SIVD will present with different subcortical features, we can predict cognitiveimpairement and early intervene and improve activity of daily living.